In a crisis such as America's coronavirus epidemic, email communication can become overwhelming—creating the risk that key information gets lost, delayed, or misdirected. Writing for the Harvard Business Review, four emergency medicine providers from Columbia University outline how you can use crisis resource management (CRM) to tame your inbox.

The authors include Marie-Laure Romney, vice chair of quality and patient safety in Columbia's emergency medicine department; Nicholas Gavin, vice chair of clinical operations and assistant professor of emergency medicine at Columbia University's Vagelos College of Physicians & Surgeons; Bernard Chang, vice chair of research and associate professor of emergency medicine at Vagelos; and David Kessler, vice chair of innovation and strategic initiatives and associate professor of pediatrics at Vagelos.

5 ways to use CRM to manage your inbox

According to the authors, CRM is a method ED doctors use during a medical emergency to communicate effectively and manage a busy ED workload. However, after America's coronavirus epidemic hit, the authors realized they could use CRM to manage a "parallel" crisis: "the flood of crisis-related email" they were receiving.

They ultimately developed five ways CRM can be used to effectively communicate via email—the "dominant form of digital communication" in a hospital.

1. Make sure communication is streamlined, and everyone knows their role

In the midst of the epidemic, many well-intentioned leaders wrote emails every day with "important but oft redundant updates," the authors explain, which made it difficult to absorb critical information during an already busy shift.

To address this issue, the authors designated one person to be the "department email summarizer," who would synthesize every update into one cohesive email—sent at the same time every day—with standardized subject lines, format, and section headings.

The authors also recommend clarifying everyone's roles within the email to ensure that people knew who was on the email and why both they and others were included. Doing so makes sure everyone on the email is aware of everyone else's expanded roles, the authors write.

2. Be clear and direct in communications

In an ED, quick, direct communication is vital to getting important information, the authors write. Specifically, the authors recommend that, when writing emails, people avoid using passive tense, direct explicitly stated requests to specific individuals, and detail firm deadlines and instructions. You can do this in your subject line, too, by writing, for example, "Subject: [Response requested by end of day] re: Status of mask delivery," the authors write.

Noting that email is "commonly abused as a tool for putting work on somebody else's desk without having to confirm that they can take it on," the writers explain that adopting this more direct approach ensures you receive a closed-loop response that your message has been received, that the task will be completed, and that you will know when it's done. Eventually, provided this practice becomes common, your team may be able to adopt a shorthand, (such as "AR = action requested, or EOD = end of day"), the authors write.

3. When added to an email, ask for clarification

It's common in a crisis for people to add others to an email thread to ensure everyone has the information they need, but it can be confusing to be brought into an email mid-conversation—and it's time-consuming to try to figure out what's happening, the authors write.

According to the authors, when someone joins a resuscitation already in progress in the ED, they're given a recap of what's going on—and the same principle can be applied to emails. If you're copied onto an email, instead of trying to figure out what's going on by yourself, ask for clarification. For instance, you could say, "'Sorry, long email sent, can you please clarify why I'm added now and how I can help?'"

4. Be aware of the situation

When many people are working at the same time in the ED, it's easy to fixate on the urgent tasks at hand and overlook another equally urgent issue, the authors write. To avoid this situation, huddles in the ED usually call for quiet in the room, which is followed by a specific plan, defined roles, and clear instructions.

Similarly, in an email, you can use a communication technique called SBAR (situation, background, assessment, and recommendation) to clearly state what's going on, what you need, and who you want (and don't want) to hear from, the authors write. Doing this helps keep everyone focused on outcomes and keeps communication concise.

5. Provide an atmosphere where people feel safe speaking up

Communication is key in the ED, but people need to feel that they can speak freely without repercussions—otherwise, they may opt to remain silent, and key information may not be mentioned, the authors write. Email can be even trickier, the authors note, because conveying tone is difficult, which means people may be more hesitant to speak up.

To help establish a sense of psychological safety, acknowledge the limitations of email from the start "to provide context and foster an open exchange," and rehearse the "communication script," such as by flagging a recommendation offered by a junior team member that hasn't yet been acknowledged, the authors write. Also, keep in mind that "some replies may be best done individually if there is any risk of somebody feeling they are being publicly reprimanded or embarrassed through reply-all," the authors add. 

"It is time to resuscitate our inboxes," the authors write. "Though there is still a lot to learn as a community about how to communicate with each other during a crisis, developing more standardized formats for email communication will help to build a culture of productive discourse using this medium" (Romney et. al., Harvard Business Review, 6/25).